I'm preparing to take the LCSW exam. As a way to study, I am following along the content areas in the guide book & I'll post regular updates with information about the various content areas. Please feel free to comment with additional information, other resources, or general commentary. Thanks for visiting!

Friday, October 7, 2011

In a suicide assessment, you want to determine lethality & severity and predict risk of immediate harm to self.Lacking a crystal ball or other psychic abilities, you will need to rely on your clinical skills, rapport with the client, information gathered from the client’s loved ones (with a release of information, naturally), and skillful use of a suicide assessment.You will need to gather information related to suicide risk factors.

So what are suicide risk factors, anyway?Risk factors are a combination of individual, relational, community, and societal factors that increase the risk of suicide. Risk factors are characteristics associated with suicide and may not be direct causes.The single greatest predictor of a future attempt is a past attempt.I will say again, the single greatest predictor of a future attempt is a past attempt.So, no matter what your setting, you should be asking, “Have you ever tried to kill yourself?”You need to be direct, and use words like kill, dead and suicide, not euphemisms, such as, “Have you ever tried to hurt yourself?”You don’t want your questions to be misunderstood on this subject.Anyway, suicide risk factors include the following:

Family history of suicide

Family history of child maltreatment

Previous suicide attempt(s)

History of mental disorders, particularly clinical depression

History of alcohol and substance abuse

Feelings of hopelessness

Impulsive or aggressive tendencies

Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)

Local epidemics of suicide

Isolation, a feeling of being cut off from other people

Barriers to accessing mental health treatment

Loss (relational, social, work, or financial)

Physical illness

Easy access to lethal methods

Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

These risk factors are lifted directly from the CDC at http://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html.The NASW adds to this being a white male over 65 or under age 30, having a medical condition, a recent discharge from a psychiatric hospital, and being single, separated or divorced. If you're like me, most of your clients have most of these risk factors. Yay for working with the vulnerable, oppressed and impoverished!

Happily, there are also some factors that seem to buffer people from suicidal ideation and attempts.However, protective factors have not been researched as extensively as risk factors have.Please do not assume that a person who has these protective factors is not a suicide risk.

Intent – level of motivation/ability to follow through w/ a suicide plan.These are questions like:

Do you have [whatever the means to the plan is] at home?

On a scale of 1 to 5, how much do you want to die?

What will happen to your [family, friends, dog, goldfish] when you die?

Have you made any preparations for what will happen after your death?

The more clear, specific and lethal the plan, the more you want to step in and take directive action. So, I would worry more about a plan like, "My wife and kids are away next weekend, and I'm going to shoot myself on Saturday night after they go," than I would worry about a plan like, "Well, I have a couple Valiums, and I might take them if I don't find a job soon." Plan A is specific, lethal, with a specific time frame. Plan B is not likely to be lethal and with no specific time frame or preparations, you may be able to talk about alternative ways of coping, use some other wonderful social work interventions, and send the client home with a plan to follow up.

A light and happy subject for a lovely Friday night!Please feel free to add your own thoughts or experience.I don’t think you can ever spend too much time learning about suicide assessment and prevention, particularly when you consider that suicide is the 4th leading cause of death for adults 18 – 65 years old.

So I went to my local NASW's exam prep class yesterday, and I am very disappointed to say that I did not find it all that beneficial. Perhaps my hopes were too high. We spent the morning reviewing Freud, Erikson, and Piaget. Then, we reviewed some diagnoses in the afternoon. So as you can see, most of what we covered, I've already talked about on this here blog. And if I do say so myself, I'm quite a bit more interesting than the ol' NASW. And a whole lot freer. I guess I did learn that I am a lot more prepared for the exam than I thought, and if you want to be prepared too, just keep on reading.

Wednesday, October 5, 2011

I'm going to a prep class tomorrow with the NASW NJ chapter. Here's hoping I'll learn some cool stuff, get some helpful pointers, and walk away feeling a little more confident (and be able to share that here). I'll try to post tomorrow and let you know how it went. Is it dorky that I'm a little excited about this?